CAJ | 학술논문

目的：通过MRI技术评估重度盆腔器官脱垂（POP）患者宫骶韧带和主韧带的形态结构，分析并探讨其临床意义。方法选择2013年11月至2014年2月在北京大学人民医院就诊的Ⅲ~Ⅳ度POP患者26例为POP组，选择同时期健康女性志愿者18例为对照组，对两组妇女行盆腔MRI检查，并建立MRI三维重建模型，细化描述并比较左、右侧宫骶韧带和主韧带在MRI上的形态学特征及其起止点附着部位。结果 POP组患者中，有25例左侧宫骶韧带起点位于骶棘韧带-尾骨肌复合体[58%（15/26）]或尾骨肌[38%（10/26）]，止点位于子宫颈和阴道[58%（15/26）]或子宫颈[38%（10/26）]；有24例右侧宫骶韧带起点位于骶棘韧带-尾骨肌复合体[31%（8/26）]或尾骨肌[62%（16/26）]，26例右侧宫骶韧带止点均位于子宫颈和阴道[62%（16/26）]或子宫颈[38%（10/26）]。两组妇女左、右侧主韧带均起自同侧骨盆侧壁坐骨大孔顶端的骶髂关节处。POP组患者中左侧主韧带止点1例（4%，1/26）完全与膀胱相连，10例（38%，10/26）部分与膀胱相连；右侧主韧带止点14例（54%，14/26）部分与膀胱相连；余左、右侧主韧带止点均位于子宫颈和（或）阴道。18例对照组妇女中有17例左侧宫骶韧带起点位于骶棘韧带-尾骨肌复合体（10/18）或尾骨肌（7/18），止点均位于子宫颈和阴道（12/18）或子宫颈（6/18）；右侧宫骶韧带起点均位于骶棘韧带-尾骨肌复合体（10/18）或尾骨肌（8/18），止点均位于子宫颈和阴道（13/18）或子宫颈（5/18）；左侧主韧带有8例（8/18）部分与膀胱相连，右侧主韧带有15例（15/18）部分与膀胱相连，余左、右侧主韧带止点均位于子宫颈和（或）阴道。两组妇女宫骶韧带和主韧带左、右侧起止点分布分别比较，差异均无统计学意义（P>0.05）。结论 MRI对POP患者在体宫骶韧带和主韧带起止点、走行方向的观察与临床解剖一致。左、右侧宫骶韧带起止点及左、右侧主韧带止点均非完全对称，变异程度很大，部分主韧带可完全或部分与膀胱相连。目的：通過MRI技術評估重度盆腔器官脫垂（POP）患者宮骶韌帶和主韌帶的形態結構，分析併探討其臨床意義。方法選擇2013年11月至2014年2月在北京大學人民醫院就診的Ⅲ~Ⅳ度POP患者26例為POP組，選擇同時期健康女性誌願者18例為對照組，對兩組婦女行盆腔MRI檢查，併建立MRI三維重建模型，細化描述併比較左、右側宮骶韌帶和主韌帶在MRI上的形態學特徵及其起止點附著部位。結果 POP組患者中，有25例左側宮骶韌帶起點位于骶棘韌帶-尾骨肌複閤體[58%（15/26）]或尾骨肌[38%（10/26）]，止點位于子宮頸和陰道[58%（15/26）]或子宮頸[38%（10/26）]；有24例右側宮骶韌帶起點位于骶棘韌帶-尾骨肌複閤體[31%（8/26）]或尾骨肌[62%（16/26）]，26例右側宮骶韌帶止點均位于子宮頸和陰道[62%（16/26）]或子宮頸[38%（10/26）]。兩組婦女左、右側主韌帶均起自同側骨盆側壁坐骨大孔頂耑的骶髂關節處。POP組患者中左側主韌帶止點1例（4%，1/26）完全與膀胱相連，10例（38%，10/26）部分與膀胱相連；右側主韌帶止點14例（54%，14/26）部分與膀胱相連；餘左、右側主韌帶止點均位于子宮頸和（或）陰道。18例對照組婦女中有17例左側宮骶韌帶起點位于骶棘韌帶-尾骨肌複閤體（10/18）或尾骨肌（7/18），止點均位于子宮頸和陰道（12/18）或子宮頸（6/18）；右側宮骶韌帶起點均位于骶棘韌帶-尾骨肌複閤體（10/18）或尾骨肌（8/18），止點均位于子宮頸和陰道（13/18）或子宮頸（5/18）；左側主韌帶有8例（8/18）部分與膀胱相連，右側主韌帶有15例（15/18）部分與膀胱相連，餘左、右側主韌帶止點均位于子宮頸和（或）陰道。兩組婦女宮骶韌帶和主韌帶左、右側起止點分佈分彆比較，差異均無統計學意義（P>0.05）。結論 MRI對POP患者在體宮骶韌帶和主韌帶起止點、走行方嚮的觀察與臨床解剖一緻。左、右側宮骶韌帶起止點及左、右側主韌帶止點均非完全對稱，變異程度很大，部分主韌帶可完全或部分與膀胱相連。
목적：통과MRI기술평고중도분강기관탈수（POP）환자궁저인대화주인대적형태결구，분석병탐토기림상의의。방법선택2013년11월지2014년2월재북경대학인민의원취진적Ⅲ~Ⅳ도POP환자26례위POP조，선택동시기건강녀성지원자18례위대조조，대량조부녀행분강MRI검사，병건립MRI삼유중건모형，세화묘술병비교좌、우측궁저인대화주인대재MRI상적형태학특정급기기지점부착부위。결과 POP조환자중，유25례좌측궁저인대기점위우저극인대-미골기복합체[58%（15/26）]혹미골기[38%（10/26）]，지점위우자궁경화음도[58%（15/26）]혹자궁경[38%（10/26）]；유24례우측궁저인대기점위우저극인대-미골기복합체[31%（8/26）]혹미골기[62%（16/26）]，26례우측궁저인대지점균위우자궁경화음도[62%（16/26）]혹자궁경[38%（10/26）]。량조부녀좌、우측주인대균기자동측골분측벽좌골대공정단적저가관절처。POP조환자중좌측주인대지점1례（4%，1/26）완전여방광상련，10례（38%，10/26）부분여방광상련；우측주인대지점14례（54%，14/26）부분여방광상련；여좌、우측주인대지점균위우자궁경화（혹）음도。18례대조조부녀중유17례좌측궁저인대기점위우저극인대-미골기복합체（10/18）혹미골기（7/18），지점균위우자궁경화음도（12/18）혹자궁경（6/18）；우측궁저인대기점균위우저극인대-미골기복합체（10/18）혹미골기（8/18），지점균위우자궁경화음도（13/18）혹자궁경（5/18）；좌측주인대유8례（8/18）부분여방광상련，우측주인대유15례（15/18）부분여방광상련，여좌、우측주인대지점균위우자궁경화（혹）음도。량조부녀궁저인대화주인대좌、우측기지점분포분별비교，차이균무통계학의의（P>0.05）。결론 MRI대POP환자재체궁저인대화주인대기지점、주행방향적관찰여림상해부일치。좌、우측궁저인대기지점급좌、우측주인대지점균비완전대칭，변이정도흔대，부분주인대가완전혹부분여방광상련。
Objective To evaluate morphological structure of uterosacral ligament (USL) and cardinal ligament (CL) in patients with severe pelvic organ prolapse (POP) by MRI technology, and to analysis and discuss its clinical significance. Methods From November 2013 to February 2014 in Peking University People′s Hospital, 26 elderly patients withⅢ-Ⅳdegree of POP were selected as the POP group and 18 healthy elderly volunteers were selected as the control group during the same period. Pelvic MRI examination were performed in the two groups. The morphological characteristics of left and right side of the uterosacral-cardinal ligament on MRI and the attachment site of the starting and ending points between two group were described and compared. Results In POP group, 25 cases of left USL starting point were located in the sacrospinous ligament/coccygeal muscle complex [58% (15/26)] or coccygeal muscle [38%(10/26)], ending point were located in the cervix and vagina [58%(15/26)] or cervix [38%(10/26)];24 cases of right USL starting point were located in the sacrospinous ligament/coccygeal muscle complex [31%(8/26)]or coccygeal muscle [62%(16/26)], 26 cases of right USL ending point were located in the cervix and vagina [62% (16/26)] or cervix [38% (10/26)]; the left and right CL in the POP group and the control group were both from the sacroiliac joint at the top of the greater sciatic foramen from the ipsilateral pelvic side wall;1 case (4%, 1/26) of left CL in the POP group completely connected to the bladder, 10 cases (38%, 10/26) partly connected to the bladder;14 cases (54%, 14/26) of right CL partly connected to the bladder, the rest ending points of left and right CL were located in cervix and (or) vagina. In the control group, 17 cases of left USL starting point were located in the sacrospinous ligament/coccygeal muscle complex (10/18) or coccygeal muscle (7/18), ending point were located in the cervix and vagina (12/18) or cervix (6/18);18 cases of right USL starting point were located in the sacrospinous ligament/coccygeal muscle complex (10/18) or coccygeal muscle (8/18), ending point were located in the cervix and vagina (13/18) or cervix (5/18);8 cases (8/18) of left CL partly connected to the bladder;15 cases (15/18) of right CL partly connected to the bladder, the rest ending points of left and right CL were located in cervix and (or) vagina. There was no significant difference between the two groups on the starting and ending points (P>0.05). Conclusions The observation of MRI could be consistent with the clinical anatomy on the starting and ending points, direction of travel in the uterosacral-cardinal ligament. The starting and ending points of the left and right side USL and the ending points of the left and right side CL are not completely symmetrical, the variation degree is large, some CL could be completely or partly inserted to the bladder.